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Lalani N, Hamash K, Wang Y. Palliative care needs and preferences of older adults with advanced or serious chronic illnesses and their families in rural communities of Indiana, USA. J Rural Health 2024; 40:368-375. [PMID: 37526585 DOI: 10.1111/jrh.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To explore the palliative care needs and preferences of older adults with advanced or serious chronic illnesses and their families. Also, to propose strategies to promote supportive palliative care in the rural communities of Indiana, USA. METHOD We conducted qualitative interviews to gather rural caregivers' experiences of palliative care. Recruitment was done in collaboration with community partners using social media, flyers, emails, invitations, and word-of-mouth. A purposive sample of family caregivers was obtained. All the interviews were conducted online. The average interview was 30-45 minutes. Data were analyzed using a thematic analysis approach. FINDINGS Our findings showed 6 major themes that indicated several palliative care needs and preferences of older patients and their families in rural communities that include: (1) difficulties in pain and symptom burden; (2) perceived discrimination and lack of trust; (3) longer distances to care facilities; (4) difficult conversations; (5) caregiving burden; and (6) use of telehealth in a rural palliative care context. CONCLUSION Rural family caregivers experience several social inequities and disparities causing a lack of access to and low utilization of palliative care. All these disparities cause several challenges for patients and their families trying to manage serious illnesses and die in place with peace and comfort. Inadequate access and lack of resources cause pain and distress for both patients and their families. Provider education and trainings, initiating early palliative care models, integrating behavioral health in palliative care, and using culturally congruent care delivery approaches in support of community partners can improve palliative care services in rural communities.
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Affiliation(s)
- Nasreen Lalani
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
- Center for Aging and Life Course Purdue University, West Lafayette, Indiana, USA
| | - Kawther Hamash
- WellStar School of Nursing, Kennesaw State University, Kennesaw, Georgia, USA
| | - Yitong Wang
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
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Gofine M, Laynor G, Schoenthaler A. Characteristics of programmes designed to link community-dwelling older adults in high-income countries from community to clinical sectors: a scoping review protocol. BMJ Open 2023; 13:e072617. [PMID: 37699628 PMCID: PMC10503318 DOI: 10.1136/bmjopen-2023-072617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Research on effectively navigating older adults into primary care is urgently needed. Community-clinic linkage models (CCLMs) aim to improve population health by linking the health and community sectors in order to improve patients' access to healthcare and, ultimately, population health. However, research on community-based points of entry linking adults with untreated medical needs into the healthcare sector is nascent. CCLMs implemented for the general adult population are not necessarily accessible to older adults. Given the recency of the CCLM literature and the seeming rarity of CCLM interventions designed for older adults, it is appropriate to employ scoping review methodology in order to generate a comprehensive review of the available information on this topic. This protocol will inform a scoping review that reviews characteristics of community-based programmes that link older adults with the healthcare sector. METHODS AND ANALYSIS The present protocol was developed as per JBI Evidence Synthesis best practice guidance and reporting items for the development of scoping review protocols. The proposed scoping review will follow Levac and colleagues' update to Arksey and O'Malley's scoping review methodology. Healthcare access at the system and individual levels will be operationalised in data extraction and analysis in accordance with Levesque and colleagues' Conceptual Framework of Access to Health. The protocol complies with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Beginning in August 2023 or later, citation databases (AgeLine (Ebsco); CINAHL Complete; MEDLINE (PubMed); Scopus Advanced (Elsevier); Social Services Abstracts (ProQuest); Web of Science Core Collection (Clarivate)) and grey literature (Google; American Public Health Association Annual Meeting Conference Proceedings; SIREN Evidence & Resource Library) will be searched. ETHICS AND DISSEMINATION The authors plan to disseminate their findings in conference proceedings and publication in a peer-reviewed journal and deposit extracted data in the Figshare depository. The study does not require Institutional Review Board approval. REGISTRATION DETAILS Protocol registered in Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/2EF9D).
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Affiliation(s)
- Miriam Gofine
- Department of Population Health, NYU Langone Health, New York City, New York, USA
- Vilcek Institute of Graduate Biomedical Sciences, NYU Langone Health, New York City, New York, USA
| | - Gregory Laynor
- Health Sciences Library, New York University Grossman School of Medicine, New York City, New York, USA
| | - Antoinette Schoenthaler
- Department of Population Health, NYU Langone Health, New York City, New York, USA
- Institute for Excellence in Health Equity, NYU Langone Health, New York City, New York, USA
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Aoun SM, Richmond R, Gunton K, Noonan K, Abel J, Rumbold B. The Compassionate Communities Connectors model for end-of-life care: implementation and evaluation. Palliat Care Soc Pract 2022; 16:26323524221139655. [PMID: 36478890 PMCID: PMC9720808 DOI: 10.1177/26323524221139655] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/31/2022] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES This pilot project aimed to develop, implement and evaluate a model of care delivered by community volunteers, called Compassionate Communities Connectors. The Connectors' principal task was to support people living with advanced life-limiting illnesses or palliative care needs by enhancing their supportive networks with Caring Helpers enlisted from the local community. METHODS The project was undertaken in Western Australia, 2020-2022. A mixed methods research design incorporated a prospective cohort longitudinal design with two cross-sectional measurements, pre- and post-intervention. The primary outcome was the effect of the intervention on social connectedness. Secondary outcomes were the effect of the intervention on unmet practical or social needs and support from social networks, and the self-reported impact of the programme on social wellbeing such as coping with daily activities, access to formal services, community links, social activity and reducing social isolation. RESULTS Twenty Connectors were trained but 13 participated; 43 patients participated but 30 completed the study. Over half of these patients lived alone and 80% of their needs were in the social domain. There were significant improvements in social connectedness, reflected in reduced social isolation, better coping with daily activities and a two-fold increase in supportive networks. The programme was able to address gaps that formal services could not, particularly for people who lived alone, or were socially isolated in more rural communities that are out of the frequent reach of formal services. CONCLUSIONS This project led to an ongoing programme that has been incorporated by the health service as 'business as usual', demonstrating rapid translation into practice. It has laid solid grounds for community capacity building with successful measurable outcomes in line with reports on similar programmes. Ongoing work is focused on replication in other communities to help them establish a similar model of care that better integrates formal and informal networks.
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Affiliation(s)
- Samar M. Aoun
- The University of Western Australia, Perth, WA,
AustraliaPerron Institute for Neurological and Translational Science, Perth,
WA, AustraliaLa Trobe University, Melbourne, VIC, Australia
| | - Robyn Richmond
- Perron Institute for Neurological and
Translational Science, Perth, WA, Australia
| | - Kerry Gunton
- Health Department of Western Australia, Perth,
WA, AustraliaPerron Institute for Neurological and Translational Science,
Perth, WA, Australia
| | - Kerrie Noonan
- Perron Institute for Neurological and
Translational Science, Perth, WA, AustraliaWestern Sydney University,
Penrith, NSW, Australia
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Noonan K, Rumbold B, Aoun SM. Compassionate community connectors: a distinct form of end-of-life volunteering. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2090051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kerrie Noonan
- Perron Institute for Neurological and Translational Science, Nedlands, Australia
- School of Social Sciences, Western Sydney University, Kingswood, Australia
| | - Bruce Rumbold
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Samar M. Aoun
- University of Western Australia, Western Australia, Australia
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Pesut B, Duggleby W, Warner G, Ghosh S, Bruce P, Dunlop R, Puurveen G. Scaling out a palliative compassionate community innovation: Nav-CARE. Palliat Care Soc Pract 2022; 16:26323524221095102. [PMID: 35592240 PMCID: PMC9112317 DOI: 10.1177/26323524221095102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background There is an urgent need for community-based interventions that can be scaled up to meet the growing demand for palliative care. The purpose of this study was to scale out a volunteer navigation intervention called Nav-CARE by replicating the program in multiple contexts and evaluating feasibility, acceptability, sustainability, and impact. Methods This was a scale-out implementation and mixed-method evaluation study. Nav-CARE was implemented in 12 hospice and 3 nonhospice community-based organizations spanning five provinces in Canada. Volunteers visited clients in the home approximately every 2 weeks for 1 year with some modifications required by the COVID-19 public health restrictions. Qualitative evaluation data were collected from key informants (n = 26), clients/family caregivers (n = 57), and volunteers (n = 86) using semistructured interviews. Quantitative evaluation data included volunteer self-efficacy, satisfaction, and quality of life, and client engagement and quality of life. Findings Successful implementation was influenced by organizational capacity, stable and engaged leadership, a targeted client population, and skillful messaging. Recruitment of clients was the most significant barrier to implementation. Clients reported statistically significant improvements in feeling they had someone to turn to, knowing the services available to help them in their community, being involved in things that were important to them, and having confidence in taking care of their illness. Improvements in clients' quality of life were reported in the qualitative data, although no statistically significant gains were reported on the quality of life measure. Volunteers reported good self-efficacy and satisfaction in their role. Conclusion The feasibility, acceptability, and sustainability of the program were largely dependent on strong intraorganizational leadership. Volunteers reported that their involvement in Nav-CARE enabled them to engage in ongoing learning and have a meaningful and relational role with clients. Clients and families described the positive impact of a volunteer on their engagement and quality of life.
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Affiliation(s)
- Barbara Pesut
- Principal Research Chair, Palliative and End of Life Care, The University of British Columbia, Okanagan Campus, 1147 Research Road, Kelowna, BC V1V 1V7, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
| | - Sunita Ghosh
- University of Alberta/Alberta Health Services, Edmonton, AB, Canada
| | - Paxton Bruce
- The University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - Rowena Dunlop
- The University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - Gloria Puurveen
- The University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
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Cheung DSK, Ho LYW, Kwok RKH, Lai DLL, Lai CKY. The effects of involvement in training and volunteering with families of people with dementia on the knowledge and attitudes of volunteers towards dementia. BMC Public Health 2022; 22:258. [PMID: 35135524 PMCID: PMC8822773 DOI: 10.1186/s12889-022-12687-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Volunteers have been a valuable resource in supporting people with dementia and their caregivers in the community. However, factors such as misconceptions, negative attitudes towards dementia, and a lack of motivation might impact the quality of volunteer care. The present paper aims to examine the effect of training and service provision on the knowledge and attitudes of volunteers towards dementia and the association between knowledge and attitudes with the levels of motivation to volunteer. METHODS The present study is part of an effectiveness-implementation cluster randomized clinical hybrid trial using a music-with-movement intervention to promote the well-being of people with dementia and their informal caregivers. Volunteers were recruited to receive training to support the delivery of the intervention. Training and enrichment workshops were offered to volunteers during the one-year project. Before and after their training and service, the recruited volunteers were asked to complete the following assessments: Dementia Attitudes Scale, and the Alzheimer's Disease Knowledge Scale. The levels of motivation to volunteer was measured with Volunteer Functions Inventory at baseline. Wilcoxon signed-rank test and multiple regression test were applied for statistical analyses. RESULTS A total of 107 volunteers were recruited, and 81 of them completed a mean period of 47.32 weeks of training and service. Significant improvements in their total score on the Alzheimer's Disease Knowledge Scale (p = .009) and Dementia Attitudes Scale (p < .001) were found. Dementia attitude (β = .57, p < .001) and knowledge (β = -.18, p = .038) were found to have the most significant association with the levels of motivation to be a volunteer at baseline. CONCLUSIONS The present study illustrated the importance of quality volunteer training and voluntary service in improving the dementia knowledge and attitudes of volunteers. It also shed light on the association between knowledge and attitudes with the levels of motivation to volunteer. Accordingly, future research and public health policymakers should address more efforts to amplify the advantage of volunteers as a vital asset in dementia care. TRIAL REGISTRATION NCT03575026 (ClinicalTrials.gov), First registration on 02/07/2018.
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Affiliation(s)
- Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Lily Yuen Wah Ho
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Robin Ka Ho Kwok
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Daniel Lok Lam Lai
- The Hong Kong Hospital Authority, Hospital Authority Building, 147B Argyle Street, Kowloon, Hong Kong
| | - Claudia Kam Yuk Lai
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Bruce P, Pesut B, Dunlop R, Puurveen G, Duggleby W. (Dis)Connecting Through COVID-19: Experiences of Older Persons in the Context of a Volunteer-Client Relationship. Can J Aging 2021; 40:1-11. [PMID: 34666866 DOI: 10.1017/s0714980821000404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The coronavirus (COVID-19) pandemic and mandated physical distancing requirements significantly impacted volunteer programs for older persons with many long-standing programs either ceasing altogether or pivoting to connecting through virtual technologies. In this study, we collected qualitative interview data from 23 clients and 33 volunteers to investigate their experiences during the COVID-19 pandemic and the effects on the volunteer-client relationship. Three themes were identified: pandemic emotions, negotiating social interactions, and growing through the COVID-19 pandemic. These findings provide important insights into the experiences of hospice organizations and their volunteers and clients during the COVID 19 pandemic, further highlighting the importance of acknowledging both older persons' vulnerability and their resilience, of building in compassionate community approaches to care, and of finding innovative ways to foster volunteer-client relationships during times when physical visiting is not possible.
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Affiliation(s)
- Paxton Bruce
- Interdisciplinary Graduate Studies, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
| | - Barbara Pesut
- School of Nursing, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
| | - Rowena Dunlop
- School of Nursing, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
| | - Gloria Puurveen
- School of Nursing, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Warner G, Kervin E, Pesut B, Urquhart R, Duggleby W, Hill T. How do inner and outer settings affect implementation of a community-based innovation for older adults with a serious illness: a qualitative study. BMC Health Serv Res 2021; 21:42. [PMID: 33413394 PMCID: PMC7792161 DOI: 10.1186/s12913-020-06031-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Implementing community-based innovations for older adults with serious illness, who are appropriate for a palliative approach to care, requires developing partnerships between health and community. Nav-CARE is an evidence-based innovation wherein trained volunteer navigators advocate, facilitate community connections, coordinate access to resources, and promote active engagement of older adults within their communities. Acknowledging the importance of partnerships between organizations, the aim of our study was to use the Consolidated Framework for Implementation Research (CFIR) to explore organizational (Inner Setting) and community or health system level (Outer Setting) barriers and facilitators to Nav-CARE implementation. Methods Guided by CFIR, qualitative individual and group interviews were conducted to examine the implementation of Nav-CARE in a Canadian community. Participants were individuals who delivered or managed Nav-CARE research, and stakeholders who provided services in the community. The Framework Method was used to analyse the data. Particular attention was paid to the host organization’s external network and community context. Results Implementation was affected by several inter-related CFIR domains, making it difficult to meaningfully separate key findings by only inner and outer settings. Thus, findings were organized into themes informed by CFIR, that cut across other domains and incorporated inductive findings: intraorganizational perceptions of Nav-CARE; public and healthcare professionals’ perceptions of palliative care; interorganizational partnerships and relationships; community and national-level factors that should have facilitated Nav-CARE implementation; and suggested changes to Nav-CARE. Themes demonstrated barriers to implementing Nav-CARE, such as poor organizational readiness for implementation, and public and health provider perceptions palliative care was synonymous with fast-approaching death. Conclusions Implementation science frameworks and theories commonly focus on assessing implementation of innovations within facilities and changing behaviours of individuals within that organizational structure. Implementation frameworks need to be adapted to better assess Outer Setting factors that affect implementation of community-based programs. Although applying the CFIR helped uncover critical elements in the Inner and Outer Settings that affected implementation of Nav-CARE. Our study suggests that the CFIR could expand the Outer Setting to acknowledge and assess organizational structures and beliefs of individuals within organizations external to the host organization who impact successful implementation of community-based innovations. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06031-6.
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Affiliation(s)
- Grace Warner
- Associate Professor School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Emily Kervin
- Mount Saint Vincent University, 166 Bedford Highway, Halifax, NS, B3M 2J6, Canada
| | - Barb Pesut
- University of British Columbia Okanagan, 1147 Research Road. Arts 3rd Floor, Kelowna, BC, V1V 1V7, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Rm 8-032, 8th floor, Centennial Building, 1678 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Wendy Duggleby
- University of Alberta, 3-141 ECHA 11405 87th Ave., Edmonton, AB, Canada
| | - Taylor Hill
- Department of Psychology and Neuroscience, Dalhousie University, 6299 South St, Halifax, NS, B3H 4J1, Canada
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Pesut B, Duggleby W, Warner G, Bruce P, Ghosh S, Holroyd-Leduc J, Nekolaichuk C, Parmar J. A mixed-method evaluation of a volunteer navigation intervention for older persons living with chronic illness (Nav-CARE): findings from a knowledge translation study. BMC Palliat Care 2020; 19:159. [PMID: 33059655 PMCID: PMC7565322 DOI: 10.1186/s12904-020-00666-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background Volunteer navigation is an innovative way to help older persons get connected to resources in their community that they may not know about or have difficulty accessing. Nav-CARE is an intervention in which volunteers, who are trained in navigation, provide services for older persons living at home with chronic illness to improve their quality of life. The goal of this study was to evaluate the impact of Nav-CARE on volunteers, older persons, and family participating across eight Canadian sites. Methods Nav-CARE was implemented using a knowledge translation approach in eight sites using a 12- or 18-month intervention period. A mixed method evaluation was used to understand the outcomes upon older person engagement; volunteer self-efficacy; and older person, family, and volunteer quality of life and satisfaction with the intervention. Results Older persons and family were highly satisfied with the intervention, citing benefits of social connection and support, help with negotiating the social aspects of healthcare, access to cost-effective resources, and family respite. They were less satisfied with the practical help available for transportation and errands. Older persons self-reported knowledge of the services available to them and confidence in making decisions about their healthcare showed statistically significant improvements (P < .05) over 12–18 months. Volunteers reported satisfaction with their role, particularly as it related to building relationships over time, and good self-efficacy. Volunteer attrition was a result of not recruiting older persons in a timely manner. There was no statistically significant improvement in quality of life for older persons, family or volunteers from baseline to study completion. Conclusions Findings from this study support a developing body of evidence showing the contributions volunteers make to enhanced older person and family well-being in the context of chronic illness. Statistically significant improvements were documented in aspects of client engagement. However, there were no statistically significant improvements in quality of life scores even though qualitative data illustrated very specific positive outcomes of the intervention. Similar findings in other volunteer-led intervention studies raise the question of whether there is a need for targeted volunteer-sensitive outcome measures. Supplementary information Supplementary information accompanies this paper at 10.1186/s12904-020-00666-2.
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Affiliation(s)
- Barbara Pesut
- University of British Columbia Okanagan, 1147 Research Road, Arts 3rd Floor, Kelowna, BC, V1V 1V7, Canada.
| | - Wendy Duggleby
- University of Alberta, 3-141 ECHA 11405 87th ave, Edmonton, Alberta, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Paxton Bruce
- University of British Columbia Okanagan, 1147 Research Road. Arts 3rd Floor, Kelowna, BC, V1V 1V7, Canada
| | - Sunita Ghosh
- University of Alberta/Alberta Health Services, 11560 University Ave, Edmonton, AB, Canada
| | | | - Cheryl Nekolaichuk
- Department of Oncology, University of Alberta, c/o Palliative Institute, Health Services Centre, DC-404, 1090 Youville Drive West, Edmonton, AB, Canada
| | - Jasneet Parmar
- Specialized Geriatrics Program, Department of Family Medicine University of AB, Medical Lead, Home Living and Transitions, AHS EZ Continuing Care, c/o Grey Nuns Community Hospital, 416 St. Marguerite Health Services Centre, 1090 Youville Drive West, Edmonton, AB, T6L 0A3, Canada
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Duggleby W, Pesut B, Warner G, Ruiz KJ, Nekolaichuk C, Ghosh S, Hallström L, Fassbender K, Swindle J, Holroyd-Leduc J, Jackman D, Woytkiw T. A Feasibility Study of a Volunteer Navigation Program in the Palliative Context. Am J Hosp Palliat Care 2020; 38:963-971. [PMID: 33030044 PMCID: PMC8212391 DOI: 10.1177/1049909120965945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS This mixed methods longitudinal study evaluated Nav-CARE for feasibility, acceptability, ease of use, and satisfaction by older persons and volunteers. METHODS Nine volunteer navigators visited 23 older persons with serious illness every 3 to 4 weeks for 1 year. Data were collected from volunteer navigators, and older person participants at baseline, during the year- long implementation and post implementation. RESULTS Volunteer navigators and older persons reported Nav-CARE was easy to use, feasible and acceptable. The majority of older persons agreed or strongly agreed that they were satisfied with the navigation services (100%; 8/8), that navigation services were important to them (87%; 7/8), that they would recommend the program to someone else (87%; 7/8), and would participate in the program again (75%; 6/8). Similarly, volunteer navigators reported 100% (9/9) satisfaction with the program, 100% (9/9) would recommend it to others, and 67% (6/8) would participate again. CONCLUSIONS Nav-CARE appears to be a feasible, acceptable, and satisfactory program for older persons with serious illness and volunteer navigators.
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Affiliation(s)
- Wendy Duggleby
- Faculty of Nursing, Edmonton Clinic Health Academy, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Barbara Pesut
- 8166University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Grace Warner
- School of Occupational Therapy, 70338Dalhousie University, Forrest Building, Halifax, Nova Scotia, Canada
| | - Kathya Jovel Ruiz
- Faculty of Nursing, Edmonton Clinic Health Academy, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, c/o Palliative Institute, Health Services Centre, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Alberta Health Services-Cancer Control Alberta, 3158University of Alberta, Edmonton, Alberta, Canada.,Department of Medical Oncology, 3158University of Alberta, Edmonton, Alberta, Canada.,Department of Mathematical and Statistical Sciences, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Lars Hallström
- Political Studies (Augustana Faculty) and REES (ALES) University of Alberta, Camrose, Alberta, Canada
| | - Konrad Fassbender
- Division of Palliative Care Medicine, Department of Oncology, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Jenny Swindle
- Faculty of Nursing, Edmonton Clinic Health Academy, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Division/Section of Geriatric Medicine, Brenda Strafford Chair in Geriatric Medicine, 70401University of Calgary, Calgary, Alberta, Canada
| | - Deirdre Jackman
- Faculty of Nursing, Edmonton Clinic Health Academy, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Terri Woytkiw
- Special Programs, Seniors Health North Zone, Onoway, Alberta, Canada
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Implementing volunteer-navigation for older persons with advanced chronic illness (Nav-CARE): a knowledge to action study. BMC Palliat Care 2020; 19:72. [PMID: 32443979 PMCID: PMC7245025 DOI: 10.1186/s12904-020-00578-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nav-CARE is a volunteer-led intervention designed to build upon strategic directions in palliative care: a palliative approach to care, a public health/compassionate community approach to care, and enhancing the capacity of volunteerism. Nav-CARE uses specially trained volunteers to provide lay navigation for older persons and family living at home with advanced chronic illness. The goal of this study was to better understand the implementation factors that influenced the utilization of Nav-CARE in eight diverse Canadian contexts. METHODS This was a Knowledge to Action study using the planned action cycle for Nav-CARE developed through previous studies. Participants were eight community-based hospice societies located in diverse geographic contexts and with diverse capacities. Implementation data was collected at baseline, midpoint, and endpoint using qualitative individual and group interviews. Field notes of all interactions with study sites were also used as part of the data set. Data was analyzed using qualitative descriptive techniques. The study received ethical approval from three university behavioural review boards. All participants provided written consent. RESULTS At baseline, stakeholders perceived Nav-CARE to be a good fit with the strategic directions of their organization by providing early palliative support, by facilitating outreach into the community and by changing the public perception of palliative care. The contextual factors that determined the ease with which Nav-CARE was implemented included the volunteer coordinator champion, organizational capacity and connection, the ability to successfully recruit older persons, and the adequacy of volunteer preparation and mentorship. CONCLUSIONS This study highlighted the importance of community-based champions for the success of volunteer-led initiatives and the critical need for support and mentorship for both volunteers and those who lead them. Further, although the underutilization of hospice has been widely recognized, it is vital to recognize the limitations of their capacity. New initiatives such as Nav-CARE, which are designed to enhance their contributions to palliative care, need to be accompanied by adequate resources. Finally, this study illustrated the need to think carefully about the language and role of hospice societies as palliative care moves toward a public health approach to care.
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Praslickova Z, Kelly M, Wiebe E. The experience of volunteer witnesses for Medical Assistance in Dying (MAiD) requests. DEATH STUDIES 2020; 46:250-255. [PMID: 31975644 DOI: 10.1080/07481187.2020.1716884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Many jurisdictions with legal forms of assisted dying require that written requests be witnessed by independent witnesses. In Canada, a unique program of volunteers was founded to make such witnesses available. A total of 106 volunteers completed a questionnaire about their experiences, challenges, and perspectives; 24 were also interviewed. Although the witnesses felt well prepared for their roles, they encountered challenges including role uncertainty, communication difficulties, and the emotional impacts of being with suffering patients and their grieving families. Most felt that the requirement for independent witnesses is an intrusive and unnecessary barrier to accessing medical assistance in dying.
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Affiliation(s)
- Zuzana Praslickova
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michaela Kelly
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ellen Wiebe
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Goehner A, Kricheldorff C, Bitzer EM. Trained volunteers to support chronically ill, multimorbid elderly between hospital and domesticity - a systematic review of one-on-one-intervention types, effects, and underlying training concepts. BMC Geriatr 2019; 19:126. [PMID: 31046693 PMCID: PMC6498473 DOI: 10.1186/s12877-019-1130-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/05/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND New approaches are needed to address the challenges of demographic change, staff shortages, and societal change in the care of the elderly. While volunteering has barely been established as a pillar of the welfare state in several countries, legislators and nonprofit or community-based organizations in some countries favor the increased integration of volunteers, as they can rely on many dedicated people. When caring for the multimorbid elderly, the transition from hospital to domesticity involves certain risks. Currently, no systematic knowledge exists on whether and how elderly benefit from volunteer support after a hospital stay. Objectives of this systematic review were to (1) identify evaluated approaches with trained volunteers supporting chronically ill, multimorbid elderly one-on-one at the interface between hospital and domesticity; (2) investigate the patient-related effectiveness of the approaches; (3) present the characteristics of the supporting volunteers; and (4) present the underlying teaching and training concepts for the volunteers. METHODS A systematic search of the following online databases was conducted in April 2017: the Cochrane Library, Medline (PubMed), CINAHL, and PsycINFO (Ebscohost). We included (cluster/quasi-) randomized controlled trials, controlled clinical trials and single-group pre-post design. An institutional search was conducted on eight national institutions from research and practice in Germany. Screening was conducted by one researcher, risk of bias was assessed. Study authors were contacted for study and training details. RESULTS We identified a total of twelve studies, eight of which evaluated treatment following hospital stay: psychosocial-coordinative support (n = 2), physical-cognitive activation (n = 4), and assistance with medication intake (n = 2). We saw short-term effects with small and medium effect sizes. Most volunteers were women aged between 45 and 61 years. Their training lasted 12-26 h and took place prior to first patient contact. During the intervention, volunteers could rely on permanent supporting structures. CONCLUSIONS Few studies exist that have evaluated one-on-one-volunteer support following hospitalization, and the effects are inconsistent. As such, further, well-designed studies are needed. The suitability and transferability of the interventions in country-specific settings should be examined in feasibility studies. Furthermore, an international discussion on the appropriate theoretical backgrounds of volunteer training is needed.
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Affiliation(s)
- Anne Goehner
- Center for Geriatric Medicine and Gerontology Freiburg, Medical Center, Faculty of Medicine, University of Freiburg, Lehener Str. 88, 79106 Freiburg, Germany
- University of Education Freiburg, Public Health & Health Education, Kunzenweg 21, 79117 Freiburg, Germany
| | - Cornelia Kricheldorff
- Catholic University of Applied Sciences Freiburg, Karlstr. 63, 79104 Freiburg, Germany
| | - Eva Maria Bitzer
- University of Education Freiburg, Public Health & Health Education, Kunzenweg 21, 79117 Freiburg, Germany
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Rawlings D, Tieman J, Miller-Lewis L, Swetenham K. What role do Death Doulas play in end-of-life care? A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e82-e94. [PMID: 30255588 DOI: 10.1111/hsc.12660] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 06/08/2023]
Abstract
Current health and social care systems do not always meet the needs of the dying in our communities. As a result, patients and families are choosing to place their trust in those who can advocate for them or fill the gaps in care. Birth Doulas have been working with women during pregnancy and after birth for many years, and we are now seeing a new role, that of a Death Doula emerging in the end-of-life care space. How Death Doulas work within health and social care systems is not understood and we conducted a systematic review to explore the published literature to explore the role and potential implications for models of care delivery. Following the PRISMA recommendations, we searched the literature in January 2018 via bibliographic databases and the grey literature without search date parameters to capture all published literature. We looked for articles that describe the role/work of a death doula or a death midwife in the context of end-of-life care, or death and dying. Our search retrieved 162 unique records of which five papers were included. We analysed the papers in relation to relationship to health service, funding source, number and demand for services, training, licensing and ongoing support, and tasks undertaken. Death Doulas are working with people at the end of life in varied roles that are still little understood, and can be described as similar to that of "an eldest daughter" or to a role that has similarities to specialist palliative care nurses. Death doulas may represent a new direction for personalised care directly controlled by the dying person, an adjunct to existing services, or an unregulated form of care provision without governing oversight.
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Affiliation(s)
- Deb Rawlings
- Palliative & Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Jennifer Tieman
- Palliative & Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lauren Miller-Lewis
- Palliative & Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kate Swetenham
- Southern Adelaide Palliative Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
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